gms | German Medical Science

Introduction: Simulation of bone drilling is an initial part of otosurgical education complementing cadaver dissections, which represent the gold standard of mastoid surgery training . Besides visualizations of the complex mastoid anatomy, various surgical procedures can virtually be performed with haptic and acoustic feedback and stereoscopic view in up to now 7 completely segmented training cases. In selected cases, preoperative patient specific modeling by 3D reconstruction of CT or DVT data is part of the clinical routine. In view of the large variety of active and passive implants nowadays available for ear surgery, it was the aim of our work to create three dimensional implant models which would broaden the range of virtual training facilities in the direction of reconstruction. Additionally, they shoud allow for patient specific spatial estimations as well as calculations of implant sizes.

Methods: Different types of implants (TORP, PORP, Stape prosthesis, implantable hearing aid, Cochlear implant) were created as virtual objects. Subsequently, they were implemented into the Voxel Man Tempo Surg training system for virtual mastoid surgery and tested with the training cases as well as different individual models.

Results: Similar to the virtual surgical tools, the implant models are controlled and positioned by the surgeon with the haptic device. Multipoint collision detection restrains the reach of action to the available space with haptic feedback.

Conclusion: The newly created virtual implant models facilitate three dimensional control training of ear implants in a complex surgical setting. They allow for the estimation of required object sizes in patient specific models. Therefore they represent a useful reconstructive addition to this surgical simulation system.